Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes

Patscheider, H.; Lorbeer, Roberto; Auweter, Sigrid; Schafnitzel, Anina; Bayerl, Christian; Curta, Adrian; Rathmann, Wolfgang; Heier, Margit; Meisinger, Christa; Peters, Annette; Bamberg, Fabian; Hetterich, Holger

doi:10.1007/s00330-017-5185-1

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…In recent decades, cardiac magnetic resonance (CMR) imaging has been commonly used in clinical practice, which can provide various characteristics of cardiac structure and myocardial tissue [8][9][10][11][12][13]. More specifically, feature tracking and first-pass perfusion of CMR imaging have been used to measure myocardial deformation and to detect microvascular dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study

Gao

Ren

Guo

et al. 2020

Cardiovasc Diabetol

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Background Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that collectively cause an increased risk of type 2 diabetes mellitus (T2DM) and nonatherosclerotic cardiovascular disease. This study aimed to evaluate the role of myocardial steatosis in T2DM patients with or without MetS, as well as the relationship between subclinical left ventricular (LV) myocardial dysfunction and myocardial steatosis. Methods and materials We recruited 53 T2DM patients and 20 healthy controls underwent cardiac magnetic resonance examination. All T2DM patients were subdivide into two group: MetS group and non-MetS. LV deformation, perfusion parameters and myocardial triglyceride (TG) content were measured and compared among these three groups. Pearson’s and Spearman analysis were performed to investigate the correlation between LV cardiac parameters and myocardial steatosis. The receiver operating characteristic curve (ROC) was performed to illustrate the relationship between myocardial steatosis and LV subclinical myocardial dysfunction. Results An increase in myocardial TG content was found in the MetS group compared with that in the other groups (MetS vs. non-MetS: 1.54 ± 0.63% vs. 1.16 ± 0.45%; MetS vs. normal: 1.54 ± 0.63% vs. 0.61 ± 0.22%; all p < 0.001). Furthermore, reduced LV deformation [reduced longitudinal and radial peak strain (PS); all p < 0.017] and microvascular dysfunction [increased time to maximum signal intensity (TTM) and reduced Upslope; all p < 0.017)] was found in the MetS group. Myocardial TG content was positively associated with MetS (r = 0.314, p < 0.001), and it was independently associated with TTM (β = 0.441, p < 0.001) and LV longitudinal PS (β = 0.323, p = 0.021). ROC analysis exhibited that myocardial TG content might predict the risk of decreased LV longitudinal myocardial deformation (AUC = 0.74) and perfusion function (AUC = 0.71). Conclusion Myocardial TG content increased in T2DM patients with concurrent MetS. Myocardial steatosis was positively associated with decreased myocardial deformation and perfusion dysfunction, which may be an indicator for predicting diabetic cardiomyopathy.

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Section: Introductionmentioning

confidence: 99%

Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study

Gao

Ren

Guo

et al. 2020

Cardiovasc Diabetol

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“…Importantly, there is a paucity of information on how SGLT2 inhibition affects the morphology and function of the RV [ 29 ]. This is surprising given that individuals with T2DM may have impaired RV systolic and diastolic function as well as decreased RV volumes, even in the absence of established coronary artery disease or HF [ 19 , 21 , 30 , 31 ]. Furthermore, T2DM is associated with RV systolic and diastolic dysfunction in the setting of HF with preserved LVEF, independent of RV afterload [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…cMRI provides the reference standard assessment of right ventricular (RV) structure and function [ 14 ], which are prognostic markers in various clinical settings including ischemic cardiomyopathy [ 15 ], non-ischemic cardiomyopathy [ 16 ], HF [ 17 ] and a multiethnic population free of CV disease [ 18 ]. T2DM affects RV remodeling, systolic and diastolic function, even in the setting of preserved LV ejection fraction (LVEF) [ 19 – 21 ]. Furthermore, T2DM is associated with RV dysfunction following ST elevation myocardial infarction [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of empagliflozin on right ventricular parameters and function among patients with type 2 diabetes

Sarak

Verma

Mazer

et al. 2021

Cardiovasc Diabetol

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Background Sodium-glucose cotransporter 2 (SGLT2) inhibition reduces cardiovascular events in type 2 diabetes (T2DM) and is associated with a reduction in left ventricular (LV) mass index. However, the impact on right ventricular (RV) remodeling is unknown. Accordingly, the objective of this study was to assess the impact of SGLT2 inhibition on RV parameters and function in T2DM and coronary artery disease (CAD). Methods In EMPA-HEART CardioLink-6, 97 patients with T2DM and CAD were randomly assigned to empagliflozin 10 mg (n = 49) once daily or placebo (n = 48). Cardiac magnetic resonance imaging was performed at baseline and after 6 months. RV mass index (RVMi), RV end-diastolic and end-systolic volume index (RVEDVi, RVESVi) and RV ejection fraction (RVEF) were assessed in blinded fashion. Results At baseline, mean RVMi (± SD) (11.8 ± 2.4 g/m2), RVEF (53.5 ± 4.8%), RVEDVi (64.3 ± 13.2 mL/m2) and RVESVi (29.9 ± 6.9 mL/m2) were within normal limits and were similar between the empagliflozin and placebo groups. Over 6 months, there were no significant differences in RVMi (− 0.11 g/m2, [95% CI − 0.81 to 0.60], p = 0.76), RVEF (0.54%, [95% CI − 1.4 to 2.4], p = 0.58), RVEDVi (− 1.2 mL/m2, [95% CI − 4.1 to 1.7], p = 0.41) and RVESVi (− 0.81 mL/m2, [95% CI − 2.5 to 0.90], p = 0.35) in the empaglifozin group as compared with the placebo group. In both groups, there was no significant correlation between RVMi and LVMi changes from baseline to 6 months. Conclusions In this post-hoc analysis, SGLT2 inhibition with empagliflozin had no impact on RVMi and RV volumes in patients with T2DM and CAD. The potentially differential effect of empagliflozin on the LV and RV warrants further investigation. Clinical Trial Registration: URL: https://www.clinicaltrials.gov/ct2/show/NCT02998970?cond=NCT02998970&draw=2&rank=1. Unique identifier: NCT02998970.

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“…Similarly, Patschneider et al showed that DM as well as prediabetes is associated with decreased RV endsystolic and enddiastolic volumes as well as stroke volumes, indicative of early-onset RV impairment prior to symptom onset. (17,18). Posttranslational modi cation (O-linked ß-N-acetylglucosamine modi cation) in DM patients may have contributed to changes in calcium sensitivity, which is a measure of impaired contractile force development.…”

Section: Discussionmentioning

confidence: 99%

Clinically Inapparent Right Heart Dysfunction is Associated with Reduced Myofilament Force Development in Coronary Artery Disease

Bening

Sales

Alhussini

et al. 2020

Preprint

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Background: Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We hypothesized that inapparent RV dysfunction in these patients is already associated with pathological changes at the level of myofilaments in concert with altered biomarkers of myocardial remodeling and endothelial dysfunction.Methods: From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥20mm, n=178;TAPSE<20mm,n=40). Baseline serum samples for biomarkers (Galectin,TGFß1,N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements.Results: Patients with TAPSE <20mm had a higher incidence of DM (55vs34%,p=0.018), preoperative AFib (43vs16%,p=0.000), reduced GFR (67±18vs77±24 ml/min/1.73m2,p=0.013), larger LA area (22±6vs20±5cm2,p=0.005) and reduced LVEF (50vs55 %,p=0.008). Furthermore, higher serum ADMA (0.70±0.13vs0.65±0.15µmol/l, p=0.046) and higher serum Pentraxin-3 levels (3371±1068vs2681±1353pg/dl,p=0.004) were observed in these Patients. Skinned fibre force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5,p<0.01 and pCa 5.75 to 6.0,p< 0.05). Multivariable analysis revealed DM (OR 2.53 CI1.12-5.73, Euro Score II (OR1.34 CI 1.02-1.78), preoperative AF (OR4.86 CI2.06-11.47), GFR (OR7.72 CI 1.87-31.96), albumin (OR1.56 CI 0.52-2.60), Pentraxin-3 (OR19.68 CI14.13-25.24), depressed LVEF (OR8.61 CI 6.37-10.86), lower force values: (pCa 5.4; OR2.34 CI 0.40-4.29 and pCa 5.2; OR2.00 CI 0.39-3.60) as predictors for clinical inapparent right heart dysfunction. Conclusions: These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.

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Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes

Abstract: • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.

Cited by 15 publications

References 30 publications

Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study

Metabolic syndrome and myocardium steatosis in subclinical type 2 diabetes mellitus: a 1H-magnetic resonance spectroscopy study

Impact of empagliflozin on right ventricular parameters and function among patients with type 2 diabetes

Clinically Inapparent Right Heart Dysfunction is Associated with Reduced Myofilament Force Development in Coronary Artery Disease

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